Automatic real-time monitoring and assessment of tremor parameters in the upper limb from orientation data

Upper limb tremor is the most prevalent movement disorder and, unfortunately, it is not effectively managed in a large proportion of the patients. Neuroprostheses that stimulate the sensorimotor pathways are one of the most promising alternatives although they are still under development. To enrich the interpretation of data recorded during long-term tremor monitoring and to increase the intelligence of tremor suppression neuroprostheses we need to be aware of the context. Context awareness is a major challenge for neuroprostheses and would allow these devices to react more quickly and appropriately to the changing demands of the user and/or task. Traditionally kinematic features are used to extract context information, with most recently the use of joint angles as highly potential features. In this paper we present two algorithms that enable the robust extraction of joint angle and related features to enable long-term continuous monitoring of tremor with context awareness. First, we describe a novel relative sensor placement identification technique based on orientation data. We focus on relative rather than absolute sensor location, because in many medical applications magnetic and inertial measurement units (MIMU) are used in a chain stretching over adjacent segments, or are always placed on a fixed set of locations. Subsequently we demonstrate how tremor parameters can be extracted from orientation data using an adaptive estimation algorithm. Relative sensor location was detected with an accuracy of 94.12% for the 4 MIMU configuration, and 100% for the 3 MIMU configurations. Kinematic tracking error values with an average deviation of 8% demonstrate our ability to estimate tremor from orientation data. The methods presented in this study constitute an important step toward more user-friendly and context-aware neuroprostheses for tremor suppression and monitoring. © 2014 Lambrecht, Gallego, Rocon and Pons.This work has been funded by the European project NeuroTremor(ICT-2011.5.1-287739)andt he Spanish Consolider project HYPER (CSD2009-00067).Peer Reviewe

Modelización del estator de un motor piezoeléctrico de onda viajera: una revision integrada y nueva perspectiva

[EN] Articles from different areas which are closely related to the modelling of the stator of travelling wave ultrasonic motors (TWUMs) are reviewed in this work. Thus, important issues relevant to this problem are identified from the areas of vibration of annular plates, laminated plate theories, and modelling of piezoelectric transducers. From this integrated point of view, it becomes clear that there are some very important issues yet to be addressed in the modelling of TWUMs. Firstly, the influence of material properties and stator dimensions on output efficiency, electromechanical coupling coefficients (EMCC) and maximum output energy is to be investigated in more detail. Secondly, the modelling of the electric potential field (by explicitly including the charge equation) for TWUMs seems to be a must for better prediction of displacements and electric fields close to the resonance, as suggested by some recent works [1]. Moreover, the improvement of current models by using shear deformation (or higher order) laminated plate theories (LPTs) in conjunction with approximated methods of solution are discussed. In addition to analytical models, those works using Finite Element and Finite difference Methods (FEM and FDM) for the modelling and simulation of the TWUM stator dynamics are reviewed.[ES] En este trabajo se realiza una revisión de los trabajos de investigación realizados en diversas áreas sobre el modelado del estátor de los motores ultrasónicos de onda viajera (TWUMs). Entre los problemas relevantes que se han estudiado podemos citar la vibración de placas anulares, las teorías de placas laminadas y el modelado de transductores piezoeléctricos. A raíz de este punto de vista integral se hace manifiesto que todavía quedan asuntos importantes que estudiar en el modelado de los TWUMs. En primer lugar, la influencia de las propiedades del material y las dimensiones del estátor en la eficiencia del motor, los coeficientes de acoplamiento electromecánico (EMCC) y la máxima energía entregada deberían ser estudiados más detenidamente. En segundo lugar, el modelado de la distribución del campo eléctrico en los TWUMs (incluyendo la ecuación de carga explícitamente) parece imprescindible para lograr una predicción mejor del desplazamiento y del campo eléctrico cerca de la resonancia, como se ha apuntado en referencias actuales [1]. Además, se discute las mejoras que incorporaría a los modelos existentes en la actualidad la inclusión de las teorías de placas laminadas (LPTs) con deformaciones de corte (o de orden superior), resueltas mediante métodos aproximados. Como complemento a los modelos analíticos, se realiza asimismo una revisión de las técnicas de elementos finitos (FEM) y diferencias finitas (FDM) empleadas en la simulación de la dinámica del estátor de los motores TWUM.The authors are thankful for the support from the National Science and Research Office (Senacyt), the Institute for Human Resource Development and Proficiency (IFARHU), both of Panama, and the European Union for its support through grant DE-4205.Peer reviewe

Automatic real-time monitoring and assessment of tremor parameters in the upper limb from orientation data

Upper limb tremor is the most prevalent movement disorder and, unfortunately, it is not effectively managed in a large proportion of the patients. Neuroprostheses that stimulate the sensorimotor pathways are one of the most promising alternatives although they are still under development. To enrich the interpretation of data recorded during long-term tremor monitoring and to increase the intelligence of tremor suppression neuroprostheses we need to be aware of the context. Context awareness is a major challenge for neuroprostheses and would allow these devices to react more quickly and appropriately to the changing demands of the user and/or task. Traditionally kinematic features are used to extract context information, with most recently the use of joint angles as highly potential features. In this paper we present two algorithms that enable the robust extraction of joint angle and related features to enable long-term continuous monitoring of tremor with context awareness. First, we describe a novel relative sensor placement identification technique based on orientation data. We focus on relative rather than absolute sensor location, because in many medical applications magnetic and inertial measurement units (MIMU) are used in a chain stretching over adjacent segments, or are always placed on a fixed set of locations. Subsequently we demonstrate how tremor parameters can be extracted from orientation data using an adaptive estimation algorithm. Relative sensor location was detected with an accuracy of 94.12% for the 4 MIMU configuration, and 100% for the 3 MIMU configurations. Kinematic tracking error values with an average deviation of 8% demonstrate our ability to estimate tremor from orientation data. The methods presented in this study constitute an important step toward more user-friendly and context-aware neuroprostheses for tremor suppression and monitoring

Advances in selective activation of muscles for non-invasive motor neuroprostheses

Non-invasive neuroprosthetic (NP) technologies for movement compensation and rehabilitation remain with challenges for their clinical application. Two of those major challenges are selective activation of muscles and fatigue management. This review discusses how electrode arrays improve the efficiency and selectivity of functional electrical stimulation (FES) applied via transcutaneous electrodes. In this paper we review the principles and achievements during the last decade on techniques for artificial motor unit recruitment to improve the selective activation of muscles. We review the key factors affecting the outcome of muscle force production via multi-pad transcutaneous electrical stimulation and discuss how stimulation parameters can be set to optimize external activation of body segments. A detailed review of existing electrode array systems proposed by different research teams is also provided. Furthermore, a review of the targeted applications of existing electrode arrays for control of upper and lower limb NPs is provided. Eventually, last section demonstrates the potential of electrode arrays to overcome the major challenges of NPs for compensation and rehabilitation of patient-specific impairments.This work has been done with partial financial support of the Ministry of Science and Innovation, in the framework of national project HYPER(CSD 2009-00067- Hybrid Neuroprosthetic and Neurorobotic Devices for Functional Compensation and Rehabilitation of Motor Disorders) and European Union in the framework of TREMOR Project: “TREMOR: An ambulatory BCI-driven tremor suppression system based on functional electrical stimulation”, ICT-2007-224051, and “NeuroTREMOR: A novel concept for support to diagnosis and remote management of tremor”, ICT-2011.5.1-287739.Peer reviewe

Event-related desynchronization-based versus bereitchaftspotential-based classfiers in stroke patiens

To compare the most well-known volitional movement-related electrophysiological phenomena for upper-limb movements in stroke patients, as source of movement classifiers.Peer Reviewe

One central oscillatory drive is compatible with experimental motor unit behaviour in essential and Parkinsonian tremor

Pathological tremors are symptomatic to several neurological disorders that are difficult to differentiate and the way by which central oscillatory networks entrain tremorogenic contractions is unknown. We considered the alternative hypotheses that tremor arises from one oscillator (at the tremor frequency) or, as suggested by recent findings from the superimposition of two separate inputs (at the tremor frequency and twice that frequency). Approach. Assuming one central oscillatory network we estimated analytically the relative amplitude of the harmonics of the tremor frequency in the motor neuron output for different temporal behaviors of the oscillator. Next, we analyzed the bias in the relative harmonics amplitude introduced by superimposing oscillations at twice the tremor frequency. These findings were validated using experimental measurements of wrist angular velocity and surface electromyography (EMG) from 22 patients (11 essential tremor, 11 Parkinson’s disease). The ensemble motor unit action potential trains identified from the EMG represented the neural drive to the muscles. Main results. The analytical results showed that the relative power of the tremor harmonics in the analytical models of the neural drive was determined by the variability and duration of the tremor bursts and the presence of the second oscillator biased this power towards higher values. The experimental findings accurately matched the analytical model assuming one oscillator, indicating a negligible functional role of secondary oscillatory inputs. Furthermore, a significant difference in the relative power of harmonics in the neural drive was found across the patient groups, suggesting a diagnostic value of this measure (classification accuracy: 86%). This diagnostic power decreased substantially when estimated from limb acceleration or the EMG. Signficance. The results indicate that the neural drive in pathological tremor is compatible with one central network providing neural oscillations at the tremor frequency. Moreover, the regularity of this neural oscillation varies across tremor pathologies, making the relative amplitude of tremor harmonics a potential biomarker for diagnostic use

Influence of common synaptic input to motor neurons on the neural drive to muscle in essential tremor

Tremor in essential tremor (ET) is generated by pathological oscillations at 4 to 12 Hz, likely originating at cerebello-thalamo-cortical pathways. However, the way in which tremor is represented in the output of the spinal cord circuitries is largely unknown because of the difficulties in identifying the behavior of individual motor units from tremulous muscles. By using novel methods for the decomposition of multichannel surface EMG, we provide a systematic analysis of the discharge properties of motor units in 9 ET patients, with concurrent recordings of EEG activity. This analysis allowed inferring the contribution of common synaptic inputs to motor neurons in ET. Motor unit short-term synchronization was significantly greater in ET patients than in healthy subjects. Further, the strong association between the degree of synchronization and the peak in coherence between motor unit spike trains at the tremor frequency indicated that the high synchronization levels were generated mainly by common synaptic inputs specifically at the tremor frequency. The coherence between EEG and motor unit spike trains demonstrated the presence of common cortical input to the motor neurons at the tremor frequency. Nonetheless, the strength of this input was uncorrelated to the net common synaptic input at the tremor frequency, suggesting a contribution of spinal afferents or secondary supraspinal pathways in projecting common input at the tremor frequency. These results provide the first systematic analysis of the neural drive to the muscle in ET and elucidate some of its characteristics that determine the pathological tremulous muscle activity.This work was funded by the EU Commission [grant number EU-FP7-2011-287739 (NeuroTREMOR)].Peer reviewe

Intramuscular EMG-Driven Musculoskeletal Modelling: Towards Implanted Muscle Interfacing in Spinal Cord Injury Patients

Objective: Surface EMG-driven modelling has been proposed as a means to control assistive devices by estimating joint torques. Implanted EMG sensors have several advantages over wearable sensors but provide a more localized information on muscle activity, which may impact torque estimates. Here, we tested and compared the use of surface and intramuscular EMG measurements for the estimation of required assistive joint torques using EMG driven modelling. Methods: Four healthy subjects and three incomplete spinal cord injury (SCI) patients performed walking trials at varying speeds. Motion capture marker trajectories, surface and intramuscular EMG, and ground reaction forces were measured concurrently. Subject-specific musculoskeletal models were developed for all subjects, and inverse dynamics analysis was performed for all individual trials. EMG-driven modelling based joint torque estimates were obtained from surface and intramuscular EMG. Results: The correlation between the experimental and predicted joint torques was similar when using intramuscular or surface EMG as input to the EMG-driven modelling estimator in both healthy individuals and patients. Conclusion: We have provided the first comparison of non-invasive and implanted EMG sensors as input signals for torque estimates in healthy individuals and SCI patients. Significance: Implanted EMG sensors have the potential to be used as a reliable input for assistive exoskeleton joint torque actuation.The authors would like to thank Enrique Pérez Rizo, Natalia Comino Suárez and María Isabel Sinovas Alonso for their assistance on the experimental and data acquisition procedure

Estudos Artísticos

O 18º número da revista croma apresenta 15 artigos que prosseguem os objetivos editoriais desta revista. Trata-se de desafiar os autores ou criadores apresentar a obra de outros artistas preferencialmente originários dos países de expressão portuguesa ou espanhola.info:eu-repo/semantics/publishedVersio

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group